1. Field of the Invention
The present invention relates to a computerized apparatus and the related system and method for local or remote rehabilitation or tele-rehabilitation and functional evaluation of hands of patients, in particular for locally or remotely evaluating the patient's progresses and training quality in the process of hand functionality rehabilitation.
In particular the present invention relates to a portable telemedicine apparatus for training and for monitoring active hand rehabilitation exercises, which the patient can autonomously execute at home without any assistance.
2. Description of the Prior Art
Recovering the hand functionality lost or reduced by injuries, interventions and chronic diseases is of particular interest because of the great impairment for the affected patients in their daily life. After the acute phase, when a pharmacological therapy should be properly set up, it is necessary to start a kinesitherapy in order to help patients in recovering their self-sufficiency, self-confidence and independence. Its effectiveness is strongly dependent on the patient's adhesion to the rehabilitation program, which can consist either of passive or active movements, exploiting or not gym tools.
Closely assisting every patient during the rehabilitation, either in person or from remote with video-based telemedicine systems, requires a huge effort, considerable costs and discomfort for the patients, being actually hardly practicable. A tele-rehabilitation system expressly designed for the hand, exploiting a store-and-forward approach with a preliminary data summarization, being able of delivering the rehabilitation services over distance without the need of a synchronization between the caregiver and the patient, can provide significant advantages in terms of costs and benefits for both the patient and the health care service provider.
There is a lack of efficient hand tele-rehabilitation known solutions for patients needing an active kinesitherapy at home, enabling the therapist to evaluate not only the results of the proposed rehabilitation program but also the quality of the patient's training, exercise by exercise.
Most of the known rehabilitation systems are based on gloves or exoskeletons, usually designed for post-stroke recovery through passive movements. In Dovat et al., “HandCARE: A cable-actuated rehabilitation system to train hand function after stroke”, IEEE Trans. on Neural Systems and Rehabilitation Engineering (2008), cable-driven units connected to each finger by means of soft rings are exploited, being able to move the fingers with predefined patterns (passive movements) and/or to provide a tunable resistance to the hand movement.
Other approaches make use of complex mechanical infrastructures or exoskeletons in order either to assist the movement, or help in restoring the motor function. These systems are usually expensive, not portable and not suitable for patients with hands deformity.
Some commercial systems allow the execution of single hand exercises, usually for evaluation purposes, such as commercial dynamometers for the hand grip strength evaluation. These systems are not designed for clinical training and can't be useful to rehabilitation purposes (usually targeted to one-shot measurements).
Commercial devices, such as Pablo® by Tyromotion GmbH, allow monitoring also the single finger pinch force. Usually the digital versions of these devices are able to provide maximum, average and standard deviation of the applied force, but without any temporal analysis within a series.
Other systems exploit tracking technology to monitor the movements during a rehabilitation session, such as electrogoniometers, as described in Durfee et al., “Design and Usability of a Home Telerehabilitation System to Train Hand Recovery Following Stroke”. Journal of Medical Devices (2009), or inertial sensors. These systems can only record the trajectory of the wrists and upper limb movements and usually depends on personal computers which guide the patient in the exercise execution (through an avatar showing the movements to execute or a little game to play) and can eventually manage the transmission of the rehabilitation movements to a medical centre. Also, console games are often used for rehabilitation purposes.